肺癌術後の遅発性気管穿孔

Delayed Tracheal Perforation after Pulmonary Resection for Lung Cancer

ソフト凝固は止血効果の高さと利便性から多くの手術で使用されている．従来の電気メスと異なり，炭化した組織の脱落やそれに伴う後出血が起きづらいことが特徴である．われわれは肺癌手術時に気管周囲でソフト凝固を使用し，遅発性気管穿孔をきたした症例を経験したので，使用上の注意や反省点を含め報告する．

We have experienced a case of delayed tracheal perforation after pulmonary resection using soft coagulation system. A 58-year-old male underwent operation for primary lung cancer. A soft coagulation system was used for oozing near upper mediastinal lymph nodes. The patient was discharged on postoperative day 8 in a good condition, however sudden tracheal perforation and was occurred on postoperative day 30. An emergency operation revealed that improper use of the soft coagulation system might cause a necrosis of the bronchial wall. Although, a soft coagulation system is useful to control bleeding from small vessels such as bronchial arteries and lymph nodes, this system is different from conventional electrocautery and requires some attention when using.